Neurotrauma - exam-focused guide
Neurotrauma covers head injury, spinal trauma and peripheral nerve injury. The exam tests resuscitation priorities, when to operate, and how to avoid secondary brain and cord injury.
Core rules
- GCS is scored on eye, verbal and motor responses; intubated patients cannot be assessed verbally, so record "V1t". A GCS ≤8 generally indicates intubation.
- Avoid hypoxia and hypotension: a single episode of systolic BP <90 mmHg worsens outcome. CPP = MAP − ICP; target CPP 60–70 mmHg in adults.
- Extradural hematoma is usually arterial (middle meningeal artery) and biconvex; subdural hematoma is venous and crescentic. Urgent surgery for clot >30 cm3, midline shift >5 mm, GCS <9 or pupillary change.
- Steroids are contraindicated in traumatic brain injury; they increase mortality. Prophylactic phenytoin may reduce early post-traumatic seizures but does not prevent late epilepsy.
- Spinal trauma: immobilize, assess ASIA level and sacral sparing. Spinal shock is flaccid areflexia after cord injury; neurogenic shock is hypotension with bradycardia from sympathetic loss.
- Peripheral nerve injury: Seddon neurapraxia, axonotmesis, neurotmesis; Sunderland grades I–V.
Worked example: A 25-year-old struck on the temple has brief loss of consciousness, a lucid interval, then deteriorates. CT shows a biconvex hyperdense collection. This is extradural hematoma. The lucid interval is classic but not universal; urgent craniotomy and clot evacuation are indicated because herniation is imminent.
Traps: relying on the lucid interval to exclude hematoma; giving steroids for brain edema; confusing spinal and neurogenic shock; missing a second spinal fracture; delaying decompression for cauda equina injury.